Primary care
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Cancer is the second leading cause of death in the United States. Cancer risk assessment can be divided into two major categories: assessment of familial or genetic risk and assessment of environmental factors that may be causally related to cancer. ⋯ Special attention should also be paid to potentially modifiable cancer risk factors in the course of advising primary care patients regarding a healthy lifestyle. Clinical guidelines, targeting both genetic and modifiable cancer risk factors, are available and can facilitate the application of these health care principles in the primary care setting.
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The prevalence of obesity has increased markedly during recent years with the burden of obesity higher in minority groups in the United States. Rates of obesity vary according to age and employment, although the effect by socioeconomic strata is diminishing. Body mass index (BMI) and waist circumference (WC) are the primary anthropometric measures of obesity, but waist-to-height is increasingly being used as a measure that identifies both overweight and metabolic risk. BMI should be interpreted with caution in the elderly, children, and some Asian populations.
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Prevalence studies show that one in five women experience an episode of major depressive disorder during their lifetime. It is important for health care providers to be aware of (1) the frequency of depression in this population; (2) signs, symptoms, and appropriate screening methods; and (3) health risks for the mother and growing fetus if depression is undetected or untreated. Because management of depressed pregnant women also includes care of a growing fetus, treatment may be complicated and primary care providers should consider a multidisciplinary approach, including an obstetrician, psychiatrist, and pediatrician, to provide optimal care.